Four-Limb Blood Pressure as Predictors of Mortality in Elderly Chinese
Four-Limb Blood Pressure as Predictors of Mortality in Elderly Chinese
复制标题
四肢血压作为中国老年人死亡率的预测指标
DOI：
10.1161/hypertensionaha.111.00969
复制
发表时间：
2013-06-01
期刊：
影响因子：
8.3
通讯作者：
Wang, Ji-Guang
中科院分区：
文献类型：
--
作者：
Sheng, Chang-Sheng;Liu, Ming;Wang, Ji-Guang
血压（BP）对心血管疾病发病率和死亡率的预测价值在老年人中下降，这可能被四肢血压差异（外周动脉疾病的标志）所混淆和补偿。在一项中国老年人（≥60岁）的前瞻性研究中，我们在仰卧位使用振荡仪同时测量四肢血压，并计算四肢之间的血压差异。在基线时，3133名参与者（1383名男性）的平均年龄为69岁。在4年（中位）随访期间，全因死亡和心血管死亡分别发生在203名和93名受试者中。在多元回归分析中，除了平均动脉压与总死亡率呈负相关（P=0.04）外，收缩压高侧臂BP不能预测死亡率（P≥0.06）。然而，在校正分析中，总死亡率与踝关节-肱血压指数下降1-SD或臂间或踝关节间血压差异增加相关的风险比为1.15至1.23 (P < 0.01)，心血管死亡率为1.17至1.24 （P < 0.04）。在分类分析中，踝关节-肱指数降低（≤0.90,≤0.95或≤1.00）或臂间或踝关节间差异增加（≥15 mm Hg或≥10 mm Hg）也观察到类似的结果。综上所述，在老年人中，臂间和臂间血压水平高于和超过臂间血压水平，并结合踝肱指数，臂间和踝间血压差异有助于预测死亡率。在目前的技术条件下，同时测量四肢血压已成为可能，并可能在心血管疾病预防中发挥作用。
The predictive value of blood pressure (BP) for cardiovascular morbidity and mortality diminishes in the elderly, which may be confounded and compensated by the BP differences across the 4 limbs, markers of peripheral arterial disease. In a prospective elderly (≥60 years) Chinese study, we performed simultaneous 4-limb BP measurement using an oscillometric device in the supine position, and calculated BP differences between the 4 limbs. At baseline, the mean age of the 3133 participants (1383 men) was 69 years. During 4 years (median) of follow-up, all-cause and cardiovascular deaths occurred in 203 and 93 subjects, respectively. In multiple regression analyses, arm BPs on the higher arm side of systolic BP did not predict mortality (P≥0.06) except for a negative association between mean arterial pressure and total mortality (P=0.04). However, in adjusted analyses, the hazard ratios associated with a 1-SD decrease in ankle-brachial BP index or increase in interarm or interankle BP difference were 1.15 to 1.23 for total mortality (P⩽0.01) and 1.17 to 1.24 for cardiovascular mortality (P⩽0.04). In categorical analyses, similar results were observed for a decreased ankle-brachial index (⩽0.90, ⩽0.95, or ⩽1.00) or increased interarm or interankle difference (≥15 mm Hg or ≥10 mm Hg). In conclusion, in the elderly, above and beyond arm BP level and together with ankle-brachial index, the interarm and interankle BP differences improve prediction of mortality. Simultaneous 4-limb BP measurement has become feasible with current technology and might be useful in cardiovascular prevention.